Cleveland medical gazette (1899) (14597558680)

Identifier: clevelandmedical1518unse (find matches)
Title: Cleveland medical gazette
Year: 1900 (1900s)
Authors:
Subjects: Medicine
Publisher: Cleveland OH : William W. Williams
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities



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which the infection was confined within theappendix, but when infection has traveled beyond the appendix,and especially if the peritoneum be involved, rigidity of abdom-inal muscles is the rule. I now come to palpation of the appendix as a most reliablemeans of diagnosis in the great majority of cases, especially in theearly acute attacks, and in chronic appendicitis (catarrhal mucusinclusion cases). This method was first published by Edebohlssome years since, but I feel sure it has not been thoroughly stud-ied and practiced by the majority of physicians, and it is for thisreason I call special attention to it. Description: With the patient in a recumbent posture theabdominal muscles will usually relax sufficiently without flexingthe legs. First, standing on the right side of the patient, place theopen hand on the right side over caecum, and maintain steadypressure for some minutes until the muscles no longer resent thismeans of provoking spasm, then, with the fingers a little to the
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Fig. 2. Mykrs: Appendicitis—Diagnosis and Treatment. 475 right of, and a little below the umbilicus with only moderate pres-sure, bring the skin outwards, as in Fig. i, until they feel thatthey have passed over the right rectus; then, without losing holdon the skin, pressure is made downward, and slightly inward,enough to insinuate the finger tips beneath the rectus (Fig. 2 ),then the skin can be loosened slightly, next exert downward pres-sure until you can distinguish the pelvic brim, and feel the pulsa-tion of the illiac artery (Fig. 3). Now, it is well to call the left hand to our assistance (Fig. 4).To maintain the pressure while the fingers of the right handmake note of what passes beneath them, slowly draw the examin-ing fingers over the posterior wall of the abdomen to the right inthe direction of the anterior superior spine of the ilium. We notesuccessively the character of the various structures as they comebeneath and escape from the fingers passing over them. In doingthi